Biggest Medicaid Changes for 2023 in the USA

Now the world has become more dynamic and uncertain than it was a decade ago. The biggest Medicaid changes for 2023 are nowhere more evident than in healthcare in the USA. Several factors contribute to the biggest Medicaid changes for 2023 in the USA. These included the aftermath of the COVID-19 pandemic combined with the adoption of technology, the financial downturn, and above all acceleration of digitization. In addition to it, Consolidated Appointment Act (CAA) was signed into law through which Congress delinked the PHE (Public Health Engineering) continuous enrolment provision from the 3rd month of 2023. That might kick off millions of people from the government-sponsored medical program. The article will discuss the biggest Medicaid changes happening in 2023 in the USA.

Biggest Medicaid Changes for 2023

Medicaid Changes for 2023

Work requirements:

To become eligible Medicaid beneficiaries, certain states in the USA sought that participants must work or participate in certain activities. However, the implementation of requirements of work and legal status has become the precursor of the latest Medicaid changes. Other requirements included income, disability, size of household, and family status highlighted in the following paragraphs.


For Medicaid coverage, the first and foremost eligibility requirement is income. Household income below 133% of the federal poverty level can make a person eligible for the Medicaid program. A single person of age above 65 years of age with less than $2,742/month income can apply for the Medicaid program.


Disability based on blindness, age, or other generally determine criteria for participants of the Medicaid program in 2023.

Household income:

Another criterion to qualify for the Medicaid program is household income. For a single adult person, it is $14580 and $30,000 for a family constituent of four members. For calculating the eligibility of large households for the Medicaid program of 2023, $5,140 should be added for each additional family member.

Family status:

Tax filler, tax dependent, and neither tax dependent nor filer are the major factors that determine the family status to qualify for the Medicaid program 2023.

Household size:

The household size in the Medicaid program is determined based on the number of family members not on their marital status. Children under 19 and parents are pregnant females and elderly people.

Expansion of Telehealth:

COVID-19 has a great role in the popularity and acceptance of telehealth services. It leads to the biggest Medicaid change in the USA in the form of expansion of the program and reimbursement for the services of telehealth. So, undeserved areas can also able access improved care.

Medicaid expansion:

The Affordable Care Act (ACA) enables many USA states to expand their Medicaid program. That contributes to covering a large number of low-income population inhabitants in the USA.

Demonstration and Waivers projects:

Another biggest Medicaid change is the application of demonstration and waiver projects for the sake of checking new approaches to Medicaid. These Medicaid changes included the addition of work requirements, the creation of new beneficiary incentives, and an alternative model of payment.

Pricing of prescribed drugs:

Medicaid drug pricing policies have been introduced in 2023 to address the rising cost of prescribed drugs. These policies address cost control measures.

Mental health and substance abuse services:

Exploration Medicaid managed care model is another biggest change that focuses on access to substance abuse and services for mental health. These services included recovery support, improvement, behavioral health, addressing of opioid crisis, and prevention treatment healthcare services.

Managed delivery and care system reforms:

USA states have been playing a great role in exploring the Medicaid manages care model. Their main focus of attention is pursuing reforms of delivery systems to enhance the coordination of care, control costs and also to improve outcomes.

Social determinants of health:

Social determinants have a great role in the health outcome. The biggest Medicaid changes in the USA incline the Medicaid program to invest in initiatives to address the social determinants of health. These social determinants are food insecurity, barriers to transportation, and housing instability.


Finally, these trend or potential changes in Medicaid program 2023 has changed the face of the Medicaid program in the USA. Now eligibility criteria have been set to qualify for Medicaid services in the USA. Income, work requirements, expansion coverage, and telehealth facilities and determinants projects contribute to the biggest changes in Medicaid changes in the USA.


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